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2002 March

Efficacy of the Alcohol Skills Training Program in Mandated and Non-Mandated Heavy Drinking College Students

Mary E. Larimer, PhD
Research Assistant Professor

Addictive Behaviors Research Center, Psychology, Psychiatry & Behavioral Sciences

Rebekka Palmer, Ph.D, Co-Investigator

Description: Research has clearly demonstrated that college students who abuse alcohol, even episodically, are at high risk for a number of negative consequences, ranging from academic impairment to death. The proposed research tests the effectiveness of the Alcohol Skills Training Program (ASTP), a motivational enhancement and skills training approach, in reducing alcohol consumption and negative consequences of students sanctioned for violations of University of Washington alcohol policies. Participants will include 270 student, 90 in each of the following groups a) first-time sanctioned students referred for mandatory alcohol education, b) heavy drinking volunteers participating in the ASTP curriculum, and c) an assessment only group of heavy drinkers. Outcomes assessed will include quantity, frequency, and peak consumption, other drug use, short- and long-term negative consequences, motivation to change, and perceived norms for alcohol use.

Using this design, we will be able to evaluate the effectiveness of the ASTP in reducing the quantity, frequency, peak consumption and negative consequences of alcohol use by mandated students in comparison to both the heavy drinking voluntary and the heavy drinking assessment only groups, In addition, we will be able to examine self-determination and readiness to change as moderators of intervention efficacy, Lastly, we will be able to assess readiness to change as a mediator of the relationship between participant status (mandatory or voluntary) and changes in alcohol consumption and alcohol related negative consequences.

Results from this study will allow for assessment and integration of effective prevention programs into the campus environment, which is essential for reducing abusive alcohol consumption and improving health and social outcomes for this population.

Resulting articles & projects:

  • Dr. Larimer received a UO I grant from NIAAA using pilot data from this project to support the application. "Alcohol Research Collaborative: Peer Projects" was funded by NIAAA from 9/30/03-7/31/08. Direct Cost amount is $1,243,001 and Total Cost is $1,794,016. 5U01AA014742-05
  • In addition, Co-PI Rebekka Palmer, Ph.D. received a pilot grant in 2005 from the Yale University Psychotherapy Development Center to further assess risky behavior (i.e., use of alcohol, drugs, tobacco, and gambling) among college students, building on results of the ADAI-funded study. The project title is Prevalence and Patterns of Risky Behavior Among College Students; $7,800 (Total Costs) (S. Ball, Co-Principal Investigator). The defensiveness measure developed as part of the ADAI funding has also been utilized in several other funded grant applications.
  • Palmer RS, Kilmer JR, Larimer ME. (2005, November). Taking the Bad with the Good: Alcohol Expectancies among Mandated and Non-Mandated Heavy Drinkers. Poster session presented at the 39th annual meeting of the Association for the Advancement of Behavior Therapy, Washington, D.C.
  • Palmer RS, Kilmer JR, Neighbors C, Larimer ME (2003, November). Practical issues in evaluating alcohol skills training with mandated heavy drinking college students. Symposium presented at the 37th annual meeting of the Association for the Advancement of Behhavior Therapy, Boston, MA.
  • Palmer RS, Kilmer JR, Ball SA, Larimer ME. Intervention defensiveness as a moderator of drinking outcome among heavy-drinking mandated college students. Addict Behav 2010;35(12):1157-60. [PubMed abstract]

A Double-blind, Double-dummy, Randomized, Prospective Efficacy Study of the Partial Mu Opiate Antagonist, Buprenorphine, for Acute Detoxification of Heroin Addicts

Andrew J. Saxon, MD
Associate Professor

Psychiatry & Behavioral Sciences

Description: Management of acute heroin withdrawal syndrome (AHWS) remains a challenge. AHWS is characterized by physical symptoms and intense opiate cravings. Acute detoxification treatments to date have been only partially effective for the physical symptoms and have been minimally effective in reducing cravings. The high mortality of heroin addiction and its costs to society are related in part to high rates of relapse secondary to intolerance of AHWS. Buprenorphine, a partial -opioid agonist, appears to ameliorate the symptoms of AHWS. Recent research shows that buprenorphine is a safe and effective alternative to methadone and levomethadyl acetate hydrochloride (LAAM) for opioid agonist treatment. However, the use of buprenorphine as a detoxification agent had been limited to only a few small studies, and the most efficacious and safe dosage schedule has yet to be determined. Currently the a-2 adrenergic receptor agonist clonidine is the mainstay of treatment for AHWS. However, clonidine lacks robust effects on withdrawal symptoms not mediated by the sympathetic nervous system and has less than optimal effects on relapse rates following completion of withdrawal.

The proposed study will be a randomized double-blind, double-dummy, placebo-controlled clinical trial comparing the efficacy of clonidine to two different dosing strategies with buprenorphine for AHWS requiring admission to an inpatient detoxification facility. Heroin dependent subjects experiencing early signs of withdrawal will be randomly assigned to 1 of 3 research conditions: 1) clonidine (control), 2) a low initial dose of buprenorphine escalating to a higher dose then tapering (experimental condition 1), or 3) an initial high dose of buprenorphine with tapering (experimental condition 2) over a five day period. Successful completion of detoxification will serve as the primary outcome measure, but impact of completed detoxification on compliance with subsequent treatment recommendations will also be studied.

Resulting articles & projects:

  • The work we accomplished did not suggest that a larger study of buprenorphine for opioid detoxification was warranted.
  • Calsyn DA, Malcy JA, Saxon AJ. Slow tapering from methadone maintenance in a program encouraging indefinite maintenance. J Subst Abuse Treat 2006;30(2):159-63. PubMed abstract
  • Jaffe C, Bush KR, Straits-Troster K, Romwall L, Rosenbaum G, Meredith C, Cherrier M, Saxon AJ. A comparison for methamphetamine-dependent inpatients with and without childhood attention deficit hyperactivity disorder symptomatology. J Addict Diseases 2005;24:133-152. [PubMed abstract]
  • Oreskovich MR, Saxon AJ, Ellis MLK, Malte CA, Reoux JP, Knox PC. A double-blind, double-dummy, randomized, prospective, pilot study of the partial mu opiate agonist, buprenorphine, for acute detoxification from heroin. Drug Alcohol Depend 2005;77:71-79. [PubMed abstract]
  • Ang-Lee K, Oreskovich MR, Saxon AJ, Jaffe C, Meredith C, Ellis ML, Malte CA, Knox PC. Single dose of 24 milligrams of buprenorphine for heroin detoxification: an open-label study of five inpatients. J Psychoactive Drugs. 2006 Dec;38(4):505-12. [PubMed abstract]
  • Oreskovich MR, Saxon AJ, Ellis MK, Malte CA, Reoux JP, Knox PC. A double-blind, Double-dummy, Randomized, Prospective, Efficacy Study of the Partial Mu Opiate Agonist, Buprenorphine, for Acute Detoxification of Heroin Addicts. Clinical Report, Syllabus and Proceedings Summary, American Psychiatric Association, 2004 Annual Meeting, P. 82, 2004.
  • Saxon AJ, Oreskovich MR, Malte CA, Ellis JK, Reoux JP, Knox PD. Monitoring for adequancy of heroin detoxification with buprenorphine or clonidine: a comparison of objective, subjective, and anlog measures. 66th Annual Meeting of College on Problems of Drug Dependence, San Juan, Puerto Rico, 2004.
  • Saxon AJ. Current and upcoming approaches to medically supervised withdrawal from opioids. Oral and Poster Presentations at the 44th Annual Meeting of the NIH New Clinical Drug Evaluation Unit (NCDEU), Phoeniz, AZ, 2004.

2002 October

Brain Substrates for the Adaptive-Response Mechanism of Tolerance to Nitrous Oxide Hypothermia

Karl J. Kaiyala, PhD
Research Assistant Professor

Dental Public Health Sciences

Douglas Ramsay, PhD, Dentistry (Co-investigator)

Description: Addictive drugs perturb variables that are subject to homeostatic control. Drug effects are thereby countered by adaptive biological responses. Many addiction researchers believe that these adaptive changes give rise to central features of the addiction phenotype, including drug tolerance, dependence and withdrawal. During an initial drug administration, reflexive adaptive responses can oppose a drug effect, causing acute (intrasessional) tolerance. With repeated drug exposures, the magnitude and timing of adaptive responses improve such that the drug has little observable effect (i.e., chronic tolerance develops).

We propose to use c-Fos immunostaining to identify brain areas that participate in neuroadaptive responses to the pharmacologically-active gas, nitrous oxide (N20). The proposed experiments exploit the principle that adaptive response mechanisms are activated only if the regulated variable is perturbed by the drug. As with ethanol, N20 has a potent hypothermic effect at typical room temperatures, and tolerance develops to this, both acutely and chronically. However, preventing ethanol-induced hypothermia by elevating ambient temperature prevents development of chronic. tolerance despite repeated drug administrations because the adaptive responses are not recruited. Accordingly, we will manipulate ambient temperature to either provide (21 C) or deny (33C) rats the hypothermic state that typically occurs with 60% nitrous oxide. Two experiments are proposed to investigate the adaptive responses that develop acutely during an initial nitrous oxide exposure, as well as chronically over repeated exposures. Core temperature, and c-Fos gene expression, a widely-used measure of neuronal activity, are the primary dependent measures. This work will be the first to identify brain areas activated by a drug-induced hypothermic stimulus and its adaptive consequences. These studies have theoretical importance for understanding drug addiction.

Resulting articles & projects:

  • This ADAI grant was instrumental in making it possible for Dr, Kaivala to obtain an NIH/NIDA R-21 grant entitled "Neuroadaptive substrates for nitrous oxide tolerance." DA17956.
  • Ramsay DS, Seaman J, Kaiyala KJ. Nitrous oxide causes a regulated hypothermia: Rats select a cooler ambient temperature while becoming hypothermic. Physiol Behav 2010 Dec 22. [PubMed abstract]
  • Ramsay DS, Watson CH, Leroux BG, Prall CW, Kaiyala KJ. Conditioned place aversion and self-administration of nitrous oxide in rats. Pharmacol Biochem Behav 2003;74(3):623-33. [PubMed abstract]

Does a Smoking Prevention Media Campaign in a Middle School Setting Change Smoking Attitudes and Behavior?

Frederick P. Rivara, MD, MPH
Professor

Pediatrics

Sarah Wiehe, MPH, PhD

Description: Smoking is the leading cause of preventable death in the United States. Most smokers start before the age of 18. Many smoking prevention programs directed at youth have been implemented. Although these programs have been associated with decreases in youth smoking prevalence, it is not known whether there is an independent effect of anti-smoking media campaigns on youth smoking attitudes and behavior. The proposed project is a randomized controlled pilot study which will examine the effect of anti-smoking advertisements viewed in a middle school setting. Two pairs of Indianapolis Public School middle schools (approximately 2000 students) will be chosen based on similar baseline smoking status, socioeconomic status and enrollment. One school in each pair will be randomized to either intervention with anti-smoking advertisements or control (activity promotion advertisements) for a four month period. Students will be followed longitudinally with a baseline and follow-up survey to assess their media exposure and smoking attitudes and behavior. We hypothesize that an anti-smoking school-based media intervention will show change in smoking attitudes and decrease in smoking prevalence compared to schools with an alternative health education media campaign.

Resulting articles & projects:

  • The data from this study were used by Dr. Wiehe as pilot data in her successful application for a K-award "Mapped and Perceived Context of Adolescent Health Risk," 1K23HD057130-02. That project has resulted in several published articles.
  • Wiehe SE, Park KJ, Christakis DA, Huhman M, Rivara FP. A Health Promotion Media Campaign in a Middle School Setting: Effect on Physical Activity, Pediatric Academic Societies Annual Meeting (Washington, DC), May 2005.
  • Wiehe SE, Park KJ, Rivara FP. A Health Promotion Media Campaign in a Middle School Setting: Effect on Smoking, Pediatric Academic Societies Annual Meeting (Washington, DC), May 2005.
  • The project served as the MPH thesis project for Dr. Sarah Wiehe.